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Monthly Archives: January 2014

How to do it : Stand with your feet together and lift your left leg with a pointed toe,putting your body weight onto the standing,right leg. Continue to lift your leg and drop the head and torso so they form a straight horizontal line from head to toe with the arms at your sides. Engage your core and make sure the left thigh, hip, and toes are aligned. Remain facing down and keep your back as straight as possible. Ensure your right knee doesn’t lock and center the weight on the middle of the foot. Hold for 5 breaths and then slowly return to standing.
Switch legs and repeat.

2.CHAIR SQUAT

How to do it: You need a chiar and your gluteus and you are good to go 🙂

Begin standing with your back to a chair, feet hip-width apart. While keeping your weight centered on your heels, draw in your abs and hinge forward at the hips slowly lowering your butt toward the chair. Pause right before you would sit down and return to standing while keeping the core engaged.
Do 3 sets of 10-15 reps.

3.PIVOTING CURTSY LUNGE

How to do it : Standing with feet hip-width apart, step your right foot diagonally behind you and into a 7 o’clock position. Bend both knees so you’re in a lunge stance. Lean your torso forward 30 degrees and pulse up and town 10-15 times. Straighten the body and pivot 180 degrees so your right foot comes to the front. Again, lower into a lunge.
Pulse up and down 10-15 times on each side to complete one set; do 3 sets.

4.LOW LUNGE HOVER

This standing move works both the legs and butt.

How to do it : Stand with feet hip-width apart before stepping your right foot back, and lowering into lunge stance with the left knee over the ankle. Bring your arms over your head and hinge forward from the waist. Lower the chest forward toward the thighs as your arms reach forward. Lift the right leg while straightening the left. Hold for 3 breaths before returning to the starting lunge position.
Do 3 reps; switch legs and repeat.

5.THE LEAN

This move works the inner thighs and begins with the same stance as the skater’s lunge.

How to do it : Begin with feet shoulder-width apart and the arms down at your sides. Take a step diagonally back with the right foot. Then, bend sideways from the waist toward the side where your right leg is stretched out, and reach your right arm up and left arm down and back toward your right calf. Return arms to starting position to complete 1 rep.
Do 10 reps, then switch sides and repeat.

6.LEG LIFT

This move targets the quads.

How to do it: While you stand facing a chair, raise your right leg, knee facing up, foot flexed and place your heel on the seat. Make sure not to lock your standing knee as you lift your right foot off the chair and straighten it out until you feel your quadriceps engage. Keeping your lifted leg in the air, bend the leg on the floor slightly and then straighten it again.
Do 10-15 reps, then switch sides and repeat for 1 full set; do 3 sets.

7.TWO-THIRDs JUMP SQUADS

Ready to work your quads and hamstrings? This move will really do the trick.

How to do it: Begin by standing with feet shoulder-width apart, arms at the sides. Lower the body into a squat, going two-thirds of the way down. Immediately jump straight up with your arms pointed up toward the ceiling. When you land, go right back into the next rep.
Do 3 sets of 20 reps each

8.V- POSITION

It is a similar position to a ballet-plié and just like the classic move,it works the thighs,hips and glutes.

How to do it: Stand holding the back of a chair with one hand. Place your feet in a V position, toes should be about 4 inches apart and heels stay pressed together. Bend your knees and lift the heels a few inches off the floor. Then, lower your hips until you feel your quads intensely working. Pulse up and down.
10-15 pulses up and down completes 1 set; do 3 sets.

9.HIP BRIDGE

This move is a modified bridge and targets the glutes.

How to do it: Lie on your back with knees bent and facing up. Plant your heels into the floor and lift the toes toward the shins. Raise the buttocks off the ground until your back forms a straight line from the knees to the shoulders. Hold for 1 second before lowering down.
Repeat for 15 reps.

10.SPLIT-SQUAT

This squat incorporates dumbbells and works to tone the thighs.

How to do it: With a 5-pound dumbbell in each hand at your sides, stand with the left foot forward and right foot back in a wide stance. Bend both knees keeping the left knee over your ankle, while lowering the right knee nearly to the floor. Return to standing.
Do 8-10 reps on each side.

11.SINGLE LEG LIFT AND ROW

This move works more than just the legs; it targets the back, arms, and core in addition to the butt and hamstrings.

How to do it: Begin standing with your left foot in front of the right foot. Hold a 5- to 8-pound dumbbell in the right hand and keep both arms at your sides. Leaning forward, raise the right foot off the ground and bring it straight up to hip level. At the same time, bring the weight toward the ground and then raise it up to hip-level.
Do 12-15 reps on the right side before switching arms and legs to repeat on the left side.

12.STANDING FORWARD BEND

This move fights cellulite and works the quad muscles.

How to do it: Stand with feet hip-width apart and hinge forward at the hips. Keep your knees slightly bent, lay the chest on your upper thighs, and let your head fall forward toward the ground. Keep the quads engaged and slowly work to straighten the legs without locking the knees. Hips should stay centered over the feet.
Hold for 5-8 slow and deep breaths.

Here are some examples of typical rehabilitation exercises for your condition. Start each exercise slowly.Ease off the exercise if you start to have pain.Your doctor or physical therapist will tell you when you can start these exercises and which ones will work best for you.

1.Quad sets

Sit with your leg straight and supported on the floor or a firm bed. (If you feel discomfort in the

front or back of your knee, place a small towel roll under your knee.)Tighten the muscles on top of your thigh by pressing the back of your knee flat down to the floor.(If you feel discomfort under your kneecap, place a small towel roll under your knee.) Hold for about 6 seconds, then rest up to 10 seconds.Do 8 to 12 repetitions several times a day.

2.Straight-leg raises to the front

Lie on your back with your good knee bent so that your foot rests flat on the floor. Your injured
leg should be straight. Make sure that your low back has a normal curve. You should be able to
slip your flat hand in between the floor and the small of your back, with your palm touching the
floor and your back touching the back of your hand.Tighten the thigh muscles in the injured leg by pressing the back of your knee flat down to the floor. Hold your knee straight. Keeping the thigh muscles tight, lift your injured leg up so that your heel is about 12 inches offthe floor. Hold for 5 seconds and then lower slowly. Do 8 to 12 repetitions.

3.Straight-leg raises to the outside

Note: Do not do this exercise unless your doctor or physical therapist says it is okay.

Lie on your side with your injured leg on top.Tighten the front thigh muscles of your injured leg to keep your knee straight.Keep your hip and your leg straight in line with the rest of your body, and keep your knee pointing forward. Do not drop your hip back.Lift your injured leg straight up toward the ceiling, about 12 inches off the floor. Hold for about 6 seconds, then slowly lower your leg. Do 8 to 12 reps.

4.Straight-leg raises to the back

Lie on your stomach, and lift your leg straight up behind you (toward the ceiling). Lift your toes about 6 inches off the floor, hold for about 6 seconds, then lower slowly. Do 8 to 12 repetitions.

5.Straight-leg raises to the inside

Note: Do not do this exercise unless your doctor or physical therapist says it is ok!

Lie on the side of your body with the injured leg.You can either prop your other (good) leg up on a chair, or you can bend your good knee and put that foot in front of your injured knee. Do not drop your hip back. Tighten the muscles on the front of your thigh to straighten your injured knee. Keep your kneecap pointing forward, and lift your whole leg up toward the ceiling about 6 inches.Hold for about 6 seconds, then lower slowly. Do 8 to 12 repetitions.

6.Hamstring curls

Lie on your stomach with your knees straight. If your kneecap is uncomfortable, roll up a
washcloth and put it under your leg just above your kneecap.Lift the foot of your injured leg by bending the knee so that you bring the foot up toward your buttocks. If this motion hurts, try it without bending your knee quite as far. This may help you avoid any painful motion.. Slowly lower your leg back to the floor.Do 8 to 12 repetitions.

With permission from your doctor or physical therapist, you may also want to add a cuff weight toyour ankle (not more than 5 pounds). With weight, you do not have to lift your leg more than 12inches to get a hamstring workout.

7.Heel raises

Stand with your feet a few inches apart, with your hands lightly resting on a counter or chair in
front of you.Slowly raise your heels off the floor while keeping your knees straight.Hold for about 6 seconds, then slowly lower your heels to the floor. Do 8 to 12 repetitions several times during the day.

8.Heel dig bridging

Note: Stop doing this exercise if it causes pain.

Lie on your back with both knees bent and your ankles bent so that only your heels are digging
into the floor. Your knees should be bent about 90 degrees.Then push your heels into the floor, squeeze your buttocks, and lift your hips off the floor until your shoulders, hips, and knees are all in a straight line.Hold for about 6 seconds as you continue to breathe normally, and then slowly lower your hips back down to the floor and rest for up to 10 seconds. Do 8 to 10 reps.

9.Half squat

Note: Do this exercise only if you have very little pain; if you have no clicking, locking, or giving way in the injured knee; and if it does not hurt while you are doing 8 to 12 repetitions.

Stand with your hands lightly resting on a counter or chair in front of you. Put your feet
shoulder-width apart.Slowly bend your knees so that you squat down like you are going to sit in a chair. Make sure your knees do not go in front of your toes.Lower yourself about 6 inches. Your heels should remain on the floor at all times.Rise slowly to a standing position.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to allappointments, and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

Accidents happen, and while many knee injuries occur during recreational activities or sports, more happen at work and at home.

Strong muscles stabilize joints. With the knee, having strong and flexible quadriceps and hamstring muscles can prevent minor stresses to the knee from causing significant injury.

Proper footwear can also minimize the risk for knee injury. Wearing shoes that are appropriate for the activity can lessen the risk of twisting and other forces that can stress the knee.

The following recommendations are designed for knee injury prevention, not performance enhancement:

Flexibility of the Hip and Thigh Musculature

In any injury prevention program, flexibility or a stretching program of the surrounding muscles is crucial. The muscles most important for prevention of knee injuries are the hip and thigh muscles: the gluteals, hip adductors or groin muscles, and the knee flexors and extensors. There are countless stretching programs, but the basic guidelines of warming up prior to exercise still ring true: warm up until you “break a sweat,” stretch each muscle group two to three times, and stretch after activity for your cool down. Stretching does not improve performance but will work to prevent injury and, as a general rule, is an absolute must if you have sustained an injury. Flexibility declines with age, so it is best to incorporate and maintain early on, since flexibility can be difficulty to regain.

Strengthening of the Hip, Thigh

As with any injury prevention program, strengthening of the muscles surrounding the knee is important. The muscles that should be the focus of a knee injury prevention program are the hip muscles: gluteus maximus or hip extensors; rectus femoris and iliopsoas or hip flexors; and the hip adductors. Also important are the knee joint, knee extensors (quadriceps group) and the knee flexors (hamstring group). Although these are the key muscles to focus on, many sources also recommend strength exercises for the lower-leg muscles such as the ankle plantarflexors and dorsiflexors.

To strengthen these areas, utilize weight machines or some other form of resistance exercise, such as sport cords or resistance tubing. Each exercise should focus on individual muscle groups and be performed in eight to 10 repetitions. Complete at least one set, increasing up to three sets, with at least 20 to 40 seconds of rest between each set. Focus on performing each exercise properly, not on doing a lot of exercise or lifting a great amount of weight.

Another second strength-training option is to use body-weight exercises such as squats, wall squats or lunges. These exercises can be done anywhere, require little space or equipment, and utilize multiple muscle groups. However, often maintaining proper form can be challenging, so use caution.

Avoid Overtraining, Regardless of Activity Choice

Overtraining is a concern with any activity, be it walking, running, swimming, or the plethora of other choices available to exercisers. The first step in avoiding knee overtraining is to choose your activity wisely to ensure it’s a good fit. For example, if you have many lower-leg problems, knee pain, or a history of back pain, a non-weight-bearing activity such as swimming may be a better choice than running. Then start slowly, with a day of rest between each exercise bout, and progress either by increasing the time of each exercise session or by adding a day of activity per week. For people who like variety, choosing different activities, often called crosstraining, is a good option. Choose a weight-bearing and a non-weight-bearing activity and alternate workouts. Regardless of the activity, be sure to use proper technique, particularly in technique-intense sports such as speed walking or swimming, and always get instruction if needed.

While direct blows to the knee will occur, the knee is more susceptible to twisting or stretching injuries, taking the joint through a greater range of motion than it can tolerate.

If the knee is stressed from a specific direction, then the ligament trying to hold it in place against that force can tear. Ligament stretching or tears are called sprains. These sprains are graded as first, second, or third degree based upon how much damage has occurred. Grade-one sprains stretch the ligament but don’t tear the fibers; grade-two sprains partially tear the fibers, but the ligament remains intact; and grade-three tears completely disrupt the ligament.

Twisting injuries to the knee put stress on the cartilage or meniscus and can pinch it between the tibial surface and the edges of the femoral condyle, causing tears.

Injuries of the muscles and tendons surrounding the knee are caused by acute hyperflexion or hyperextension of the knee or by overuse. These injuries are called strains. Strains are graded similarly to sprains, with first-degree strains stretching muscle or tendon fibers but not tearing them, second-degree strains partially tearing the muscle tendon unit, and third-degree strains completely tearing it.

There can be inflammation of the bursas (known as bursitis) of the knee that can occur because of direct blows or chronic use and abuse.

Acute knee injuries fall into two groups; those where there is almost immediate swelling in the joint associated with the inability to bend the knee and bear weight, and those in which there is discomfort and perhaps localized pain to one side of the knee, but with minimal swelling and minimal effects on walking.

Acute knee injuries can cause pain and swelling with difficulty bending the knee and weight-bearing. If the swelling occurs immediately, it may suggest a ligament tear or fracture. If the swelling arises over a period of many hours, meniscal or cartilage injuries may be the cause. However, injuries to the knee may involve more than one structure and the symptoms may not present classically.

Longer-term symptoms that point to knee problems will include pain and swelling in addition to other complaints. Inflammation in the joint may be caused by even minor activity. Swelling may be intermittent, brought on by activity, and may gradually resolve as the inflammation decreases.

Pain, too, may come and go and may not occur right away with activity but might be delayed as the inflammation develops. Pain can also be felt with specific activities. Pain while climbing stairs is a symptom of meniscus injury, where the cartilage is being pinched in the joint as it narrows with bending. Pain with walking down stairs suggests patellar pain, where the kneecap is being forced onto the femur.

Giving way, or a feeling of instability of the knee, or, popping or grinding in the knee is associated with cartilage or meniscus tears. “Locking” is the term used when the knee joint refuses to completely straighten, and this is almost always due to torn cartilage. In this situation, the torn piece of cartilage folds upon itself and doesn’t allow the knee to extend.

Knee Injury Treatment

Almost all knee injuries will need more than one visit to the doctor. If no operation is indicated, then RICE (rest, ice, compression, and elevation) with some strengthening exercises and perhaps physical therapy will be needed. Sometimes the decision for surgery is delayed to see if the RICE and physical therapy will be effective. Each injury is unique, and treatment decisions depend on what the expectation for function will be. As an example, a torn ACL (anterior cruciate ligament) would usually require surgery in a young athlete or a construction worker, but the ACL may be allowed to heal with physical therapy in an 80-year-old who is not very mobile.

Almost all of these strains are treated with ice, elevation, and rest. Sometimes compression with an Ace wrap or knee sleeve is recommended, and crutches may be used for a short time to assist with walking. Ibuprofen(Advil) can be used as an anti-inflammatory medication.

The mechanism of injury is either hyperextension, in which the hamstring muscles can be stretched or torn, or hyperflexion, in which the quadriceps muscle is injured. Uncommonly, with a hyperflexion injury, the patellar or quadriceps tendon can be damaged and rupture. This injury is characterized by the inability to extend the knee and a defect that can be felt either above or below the patella. Surgery is required to repair this injury.

Except for elite athletes, tears of the hamstring muscle are treated conservatively without an operation, allowing time, exercise, and perhaps physical therapy to return the muscle to normal function.

MCL and LCL Injuries

These ligaments can be stretched or torn when the foot is planted and a sideways force is directed to the knee. This can cause significant pain and difficulty walking as the body tries to protect the knee, but there is usually little swelling within the knee. The treatment for this injury may include a knee immobilizer, a removable Velcro splint that keeps the knee straight and keeps the knee stable. RICE (rest, ice, compression, and elevation) are the mainstays of treatment.

ACL Injuries

If the foot is planted and there is force applied from the front or back to the knee, then the cruciate ligaments can be damaged. Swelling in the knee occurs within minutes, and attempts at walking are difficult. The definitive diagnosis is difficult in the emergency department because the swelling and pain make it hard to test if the ligament is loose. Long-term treatment may require surgery and significant physical therapy to return good function of the knee joint. Recovery from these injuries is measured in months, not weeks.

Meniscus Tears

The cartilage of the knee can be acutely injured or can gradually tear. Acutely, the injury is of a twisting nature; the cartilage that is attached to and lays flat on the tibia is pinched between the femoral condyle and the tibial plateau. Pain and swelling occur gradually over many hours (as opposed to an ACL tear which swells much more quickly). Sometimes the injury seems trivial and no care is sought, butchronic pain develops over time. There may be intermittent swelling, pain with walking uphill or climbing steps, or giving way of the knee that results in near falls. History and physical examination often can make the diagnosis and MRI may be used to confirm it.

Bursa Inflammation

Housemaid’s knee (prepatellar bursitis) is due to repetitive kneeling and crawling on the knees. The bursa or space between the skin and kneecap becomes inflamed and fills with fluid. It is a localized injury and does not involve the knee itself. Treatment includes padding the knee and using ibuprofen as an anti-inflammatory medication. This injury is commonly seen in carpet installers and roofers.

Patellar Injuries

The kneecap sits within the tendon of the quadriceps muscle, in front of the femur, just above the knee joint. It is held in place by the muscles of the knee.

The patella can dislocate laterally (toward the outside of the knee). This occurs more commonly in women because of anatomic differences in the angle aligning the femur and tibia. Fortunately, the dislocation is easily returned to the normal position by straightening out the knee, usually resulting in the kneecap popping into place. Physical therapy for muscle strengthening may be needed to prevent recurrent dislocations.

Patello-femoral syndrome occurs when the underside of the patella becomes inflamed if irritation develops as it rides its path with each flexion and extension of the knee, and it does not track smoothly. This inflammation can cause localized pain, especially with walking down stairs and with running. Treatment includes ice, anti-inflammatory medication, and exercises to balance the quadriceps muscle. More severe cases may require arthroscopic surgery to remove some of the inflamed cartilage and realign parts of the quadriceps muscle.

Fractures

Fractures of the bones of knee are relatively common. The patella, or kneecap, may fracture due to a fall directly onto it or in car accidents, when the knee is driven into the dashboard. If the bone is pulled apart, surgery will be required for repair, but if the bone is in good position, a knee immobilizer and watchful waiting may be all that is required.

The head of the fibula on the lateral side of the knee joint can be fractured either by a direct blow or as part of an injury to the shin or ankle. This bone usually heals with little intervention, but fractures of this bone can have a major complication. The peroneal nerve wraps around the bone and can be damaged by the fracture. This will cause a foot drop, so do not be surprised if the physician examines your foot when you complain of knee problems.

With jumping injuries, the surface of the tibia can be damaged, resulting in a fracture to the tibial plateau. Since this is where the femoral condyle sits to move the knee joint, it is important that it heals in the best position possible. For that reason, after plain X-rays reveal this fracture, a CT scan is done to make certain that there is no displacement of the bones. Occasionally, this type of fracture requires surgery for repair.

Fractures of the femur require significant force, but in people with osteoporosis, less force is needed to cause a fracture of this large bone. In people with knee replacements who fall, there is a potential weakness at the site of the knee replacement above the femoral condyle, and this can be a site of fracture. The decision to operate or treat by immobilization with a cast will be made by the orthopedist.

The purpose of the knee is the following: It need to flex (bend) or extend ( straighten) to allow our body to perform different activities like : running,walking,kicking,sitting. Imagine standing up from a chair or running if your legs couldn´t bend.

Let´s talk a bit about the knee anatomy:

The knee is one of the largest and most complex joints in the body. The knee joins the thigh bone (femur) to the shin bone (tibia). The smaller bone that runs alongside the tibia (fibula) and the kneecap (patella) are the other bones that make the knee joint.

Tendons connect the knee bones to the leg muscles that move the knee joint. Ligaments join the knee bones and provide stability to the knee:

The anterior cruciate ligament prevents the femur from sliding backward on the tibia (or the tibia sliding forward on the femur).

The posterior cruciate ligament prevents the femur from sliding forward on the tibia (or the tibia from sliding backward on the femur).

The medial and lateral collateral ligaments prevent the femur from sliding side to side.

Two C-shaped pieces of cartilage called the medial and lateral menisci act as shock absorbers between the femur and tibia.

Numerous bursae, or fluid-filled sacs, help the knee move smoothly.

There are two major muscle groups that are balanced and allow movement of theknee joint. When the quadriceps muscles on the front of the thigh contract, the knee extends or straightens. The hamstring muscles on the back of the thigh flex or bend the knee when they contract. The muscles cross the knee joint and are attached to the tibia by tendons. The quadriceps tendon is a little special, in that it contains the patella within it. The patella allows the quadriceps muscle/tendon unit to work more efficiently. This tendon is renamed the patellar tendon in the area below the kneecap to its attachment to the tibia.

The stability of the knee joint is maintained by four ligaments, thick bands of tissue that stabilize the joint. The medial collateral ligament (MCL) and lateral collateral ligament (LCL) are on the sides of the knee and prevent the joint from sliding sideways. The anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) form an “X” on the inside of the knee and prevent the knee from sliding back and forth. These limitations on knee movement allow the knee to concentrate the forces of the muscles on flexion and extension.

Inside the knee, there are two shock-absorbing pieces of cartilage called menisci (singular meniscus) that sit on the top surface of the tibia. The menisci allow the femoral condyle to move on the tibial surface without friction, preventing the bones from rubbing on each other. Without the menisci, the friction of bone on bone would cause inflammation, or arthritis.

Bursas surround the knee joint and are fluid-filled sacs that cushion the knee during its range of motion. In the front of the knee, there is a bursa between the skin and the kneecap called the prepatellar bursa and another above the kneecap called the suprapatellar bursa (supra=above).

Each part of the anatomy needs to function properly for the knee to work. Acute injury or trauma as well as chronic overuse both cause inflammation and its accompanying symptoms of pain, swelling, redness, and warmth.